Clinical colorectal cancer最新文献

{"title":"Adjuvant Chemotherapy for Older Patients With Stage III Colorectal Cancer: A Real-World Analysis of Treatment Recommendations, Treatment Administered and Impact on Cancer Recurrence","authors":"Oliver Piercey ,&nbsp;Hui-Li Wong ,&nbsp;Clara Leung ,&nbsp;Yat Hang To ,&nbsp;Valerie Heong ,&nbsp;Margaret Lee ,&nbsp;Jeanne Tie ,&nbsp;Malcolm Steel ,&nbsp;Justin M. Yeung ,&nbsp;Jacob McCormick ,&nbsp;Peter Gibbs ,&nbsp;Rachel Wong","doi":"10.1016/j.clcc.2024.01.001","DOIUrl":"10.1016/j.clcc.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p><span>A substantial proportion of patients with stage III colorectal cancer (CRC) are older than 70 years. Optimal adjuvant chemotherapy (AC) for older patients (OP) continues to be debated, with subgroup analyses of randomized trials not demonstrating a survival benefit from the addition of </span>oxaliplatin<span><span> to a fluoropyrimidine </span>backbone.</span></p></div><div><h3>Patients and Methods</h3><p>We analyzed the multisite Australian ACCORD registry, which prospectively collects patient, tumor and treatment data along with long term clinical follow-up. We compared OP (≥70) with stage III CRC to younger patients ([YP] &lt;70), including the proportion recommended AC and any reasons for not prescribing AC. AC administration, regimen choice, completion rates, and survival outcomes were also examined.</p></div><div><h3>Results</h3><p>One thousand five hundred twelve patients enrolled in the ACCORD registry from 2005 to 2018 were included. Median follow-up was 57.0 months. Compared to the 827 YP, the 685 OP were less likely to be offered AC (71.5% vs. 96.5%, <em>P</em> &lt; .0001) and when offered, were more likely to decline treatment (15.1% vs. 2.8%, <em>P</em> &lt; .0001). Ultimately, 60.0% of OP and 93.7% of YP received AC (<em>P</em> &lt; .0001). OP were less likely to receive oxaliplatin (27.5% vs. 84.7%, <em>P</em> &lt; .0001) and to complete AC (75.9% vs. 85.7%, <em>P</em> &lt; .0001). The probability of remaining recurrence-free was significantly higher in OP who received AC compared to those not treated (HR 0.73, <em>P</em> = .04) but not significantly improved with the addition of oxaliplatin (HR 0.75, <em>P</em> = .18).</p></div><div><h3>Conclusion</h3><p>OP were less likely than YP to receive AC. Receipt of AC reduced recurrences in OP, supporting its use, although no significant benefit was observed from the addition of oxaliplatin.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"23 1","pages":"Pages 95-103.e3"},"PeriodicalIF":3.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139464766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Pyrotinib With/Without Trastuzumab in Treatment-Refractory, HER2-Positive Metastatic Colorectal Cancer: Result From a Prospective Observational Study","authors":"Haojie Zhou ,&nbsp;Minzhi Lv ,&nbsp;Wei Li ,&nbsp;Yan Wang ,&nbsp;Jing Wu ,&nbsp;Qing Liu ,&nbsp;Tianshu Liu ,&nbsp;Yuehong Cui ,&nbsp;Qian Li","doi":"10.1016/j.clcc.2023.10.008","DOIUrl":"10.1016/j.clcc.2023.10.008","url":null,"abstract":"<div><h3>Background</h3><p><span>Human epidermal growth factor<span> receptor 2 (HER2) is a promising therapeutic target in metastatic colorectal cancer (mCRC). This study was to evaluate the efficacy and safety of pyrotinib alone or pyrotinib with </span></span>trastuzumab<span> in patients with HER2-positive mCRC.</span></p></div><div><h3>Patients and Methods</h3><p><span><span>In this prospective observational study, patients with HER2 positive, Ras Sarcoma </span>Viral Oncogene<span> Homolog (RAS) wild type mCRC who received at least one standard treatment of palliative chemotherapy were enrolled. Patients were treated with oral pyrotinib alone or pyrotinib with trastuzumab. The primary endpoint was </span></span>progression free survival (PFS), and the secondary endpoints were overall survival (OS), confirmed objective response rate (ORR), and safety. This trial is registered with chitcr.org, number ChiCTR2100046381.</p></div><div><h3>Results</h3><p>From February 15, 2021, to January 10, 2023, 32 patients were enrolled in this study. Twenty (62.5%) patients were treated with pyrotinib, while 12 (37.5%) received pyrotinib and trastuzumab. As of June 24, 2023, with a median follow-up of 11.0 months, the median PFS was 5.7 months (95%CI 4.5-10.2), while OS was not evaluable (NE), ORR and disease control rate (DCR were 34.4% and 87.5%. Patients’ PFS in the pyrotinib plus trastuzumab subgroup and pyrotinib monotherapy<span> group were 8.6 and 5.5 months, OS was not evaluable (NE) and 10.9 months, ORR was 50.0% and 25.0%, respectively. Most treatment-related adverse events (TRAEs) were grade 1-2, diarrhea was the most frequent TRAE (81.3%, 26/32). Grade 3 TRAEs occurred in 11 patients: 9 for diarrhea, 1 for nausea, and 1 for oral mucositis.</span></p></div><div><h3>Conclusion</h3><p>Pyrotinib with or without trastuzumab showed promising anti-tumor activity and acceptable toxicities in treatment-refractory, HER2-positive mCRC.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"23 1","pages":"Pages 58-66"},"PeriodicalIF":3.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138525574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of Primary Tumor Sidedness in Stage III Colorectal Cancer: Real-World Evidence from a Brazilian Cohort","authors":"Bruno Medonça Protásio ,&nbsp;Tiago Biachi de Castria ,&nbsp;Renato Natalino ,&nbsp;Flávia R. Mangone ,&nbsp;Daniel Fernandes Saragiotto ,&nbsp;Jorge Sabbaga ,&nbsp;Paulo M. Hoff ,&nbsp;Roger Chammas","doi":"10.1016/j.clcc.2023.12.001","DOIUrl":"10.1016/j.clcc.2023.12.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Primary tumor sidedness (PTS) is an independent prognostic factor </span>in patients<span> with metastatic colorectal cancer (CRC), with a worse prognosis for right-sided tumors. There are limited data on the prognostic impact of PTS in stage III CRC. The main objective of this study was to analyze the prognostic impact of PTS in stage III CRC.</span></p></div><div><h3>Patients and Methods</h3><p><span><span>A retrospective and uni-institutional cohort study<span> was performed in an oncology reference center. Patients with stage III CRC treated with a 5-fluorouracil and oxaliplatin-based </span></span>chemotherapy regimen (mFLOX regimen) from October 2007 to February 2013 were included. The primary outcome was the probability of overall survival (OS) at 5 years stratified by PTS. Secondary outcomes were the probability of disease-free survival (DFS) at 5 years and an analysis of the prognostic impact of clinical and molecular biomarkers. Kaplan‒Meier curves were used, and </span>Cox models were used to evaluate prognostic factors associated with OS and DFS.</p></div><div><h3>Results</h3><p><span>Overall, 265 patients were evaluated. Transverse colon tumors, multicentric tumors, and undetermined primary subsites were excluded, resulting in 234 patients classified according to PTS: 95 with right sidedness (40.6%) and 139 with left sidedness (59.4%). The median follow-up time was 66 months [interquartile range (IQR): 39-81]. The 5-year OS probabilities for right-sided and left-sided tumors were 67% (95% CI: 58%-77%) and 82% (75%-89%), respectively [hazard ratio (HR): 2.02, 95% CI: 1.18-3.46; </span><em>P</em> = .010]. The 5-year probabilities of DFS for right-sided and left-sided tumors were 58% (49%-69%) and 65% (58%-74%), respectively (HR: 1.29, 0.84-1.97; <em>P</em> = 0.248).</p></div><div><h3>Conclusion</h3><p>These data suggest that there may be a worse prognosis (inferior OS at 5 years) for resected right-sided stage III CRC patients treated in the real world. However, these data need to be confirmed by prospective studies with a larger number of participants.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"23 1","pages":"Pages 73-84"},"PeriodicalIF":3.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138560722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Management of Gastrointestinal and Liver Toxicities of Immune Checkpoint Inhibitors","authors":"Kevin Mok ,&nbsp;Claudia Wu ,&nbsp;Stephen Chan ,&nbsp;Grace Wong ,&nbsp;Vincent Wai-Sun Wong ,&nbsp;Brigette Ma ,&nbsp;Rashid Lui","doi":"10.1016/j.clcc.2023.12.003","DOIUrl":"10.1016/j.clcc.2023.12.003","url":null,"abstract":"<div><p><span><span>Immune checkpoint inhibitors<span> have transformed the treatment paradigm for various types of cancer. Nonetheless, with the utilization of these groundbreaking treatments, immune-related adverse events (irAEs) are increasingly encountered. Colonic and hepatic involvement are among the most frequently encountered irAEs. Drug-induced side effects, infectious causes, and tumor-related </span></span>symptoms<span><span> are the key differentials for irAE complications. Potential risk factors for the development of irAEs include combination use of immune checkpoint inhibitors, past development of irAEs with other immunotherapy<span> treatments, certain concomitant drugs, and a pre-existing personal or family history of autoimmune illness such as </span></span>inflammatory bowel disease. The importance of early recognition, timely and proper management cannot be understated, as there are profound clinical implications on the overall cancer treatment plan and prognosis once these adverse events occur. Herein, we cover the clinical management of the well-established gastrointestinal irAEs of </span></span>enterocolitis and hepatitis, and also provide an overview of several other emerging entities.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"23 1","pages":"Pages 4-13"},"PeriodicalIF":3.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138687834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant Immunotherapy With Ipilimumab Plus Nivolumab in Mismatch Repair Deficient/Microsatellite Instability-High Colorectal Cancer: A Preliminary Report of Case Series","authors":"Tao Pan ,&nbsp;Hui Yang ,&nbsp;Wu-yi Wang ,&nbsp;Yuan-yi Rui ,&nbsp;Zi-jian Deng ,&nbsp;Yung-chang Chen ,&nbsp;Chao Liu ,&nbsp;Hai Hu","doi":"10.1016/j.clcc.2024.01.002","DOIUrl":"10.1016/j.clcc.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Although ipilimumab<span> plus nivolumab<span><span> have significantly improved the survival of metastatic colorectal cancer (CRC) with </span>mismatch repair deficient (dMMR) /microsatellite instability-high (MSI-H), the data on neoadjuvant setting is limited.</span></span></p></div><div><h3>Patients and Methods</h3><p>We enrolled 11 patients with advanced dMMR/MSI-H CRC. 10 patients were locally advanced and 1 was metastatic. Ten patients were treated with 1 dose of ipilimumab (1 mg/kg) and 2 doses of nivolumab (3 mg/kg), and 1 patient was treated with 1 dose of ipilimumab (1 mg/kg) and 2 doses of nivolumab (3 mg/kg) with 2 cycles. All the patients underwent surgery after immunotherapy. The aim of the study was to evaluate the safety and short-term efficacy of this strategy.</p></div><div><h3>Results</h3><p><span>Pathologic responses were observed in 11/11 (100%) dMMR/MSI-H tumors, with 9/11 (81.8%) achieving complete responses. Among these 9 cases with complete responses, 1 achieved a radiological noncomplete response after treatment with 1 dose of ipilimumab (1 mg/kg) and 2 doses of nivolumab (3 mg/kg), so another cycle of treatment with 1 dose of ipilimumab (1 mg/kg) and 2 doses of nivolumab (3 mg/kg) was administered, followed by surgery. The postoperative pathological evaluation was a complete response. Seven patients (63.6%) developed grade I/II adverse events. No patients developed grade III/IV adverse events or </span>postoperative complications.</p></div><div><h3>Conclusion</h3><p>Neoadjuvant immunotherapy with ipilimumab plus nivolumab induced tumor regression with a major clinical and pathological response in advanced dMMR/MSI-H CRC. Notably, patients do not achieve a complete response to neoadjuvant immunotherapy, additional neoadjuvant immunotherapy may offer benefits. Further research is needed to assess the long-term efficacy of this strategy.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"23 1","pages":"Pages 104-110"},"PeriodicalIF":3.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139506388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Biologic Agents Among Hispanic Patients With Metastatic Colorectal Cancer","authors":"Riya Patel ,&nbsp;Abdissa Negassa ,&nbsp;Seda S. Tolu ,&nbsp;Ana Acuna-Villaorduna ,&nbsp;Sanjay Goel","doi":"10.1016/j.clcc.2023.10.001","DOIUrl":"10.1016/j.clcc.2023.10.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Randomized clinical trials<span> have defined the survival advantage with the addition of biologic drugs to chemotherapy in patients with </span></span>metastatic colorectal cancer (mCRC). Under representation of Hispanics contributes to poorly defined outcomes in this group. We aim to determine whether the real-world benefit of biologics extends to Hispanics using a comparative effectiveness research approach.</p></div><div><h3>Methods</h3><p><span>This retrospective cohort study<span> included all treatment centers contributing to SEER registry with available claims in the SEER-Medicare linked database (2001-2011) and 2 hospitals (2004-2016) catering to minorities. Metastatic CRC patients were </span></span><em>classified as receiving chemotherapy or biochemotherapy (CT plus biologics; if initiated within 3 months of chemotherapy).</em><span> The primary outcome was overall survival (OS) among the Hispanic patients calculated from time of administration of first dose of chemotherapy to death or last follow-up. A weighted Cox regression model was used to assess differences in survival.</span></p></div><div><h3>Results</h3><p>We identified 182 Hispanic patients with mCRC from the Patient Entitlement and Diagnosis Summary (PEDSF) file (n = 101) and hospital database (n = 81). Overall, 52% were women and 72% received biologics. The median OS was 11.3 and 17.0 months in chemotherapy and biochemotherapy group, respectively. Biochemotherapy offered a survival benefit compared with chemotherapy alone, with an average hazard rate reduction of 39% (95% CI 6%-60%, <em>p</em> = .0236) using inverse probability of treatment weighting (IPTW) based analysis.</p></div><div><h3>Conclusion</h3><p>In this cohort of Hispanic patients with mCRC, biochemotherapy was associated with longer survival. Clinicians may offer biochemotherapy therapy to all patients regardless of race/ethnicity to maximize clinical benefit.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"23 1","pages":"Pages 14-21.e1"},"PeriodicalIF":3.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ongoing Clinical Trials and Future Research Scenarios of Circulating Tumor DNA for the Treatment of Metastatic Colorectal Cancer","authors":"Laura Roazzi ,&nbsp;Giorgio Patelli ,&nbsp;Katia Bruna Bencardino ,&nbsp;Alessio Amatu ,&nbsp;Erica Bonazzina ,&nbsp;Federica Tosi ,&nbsp;Brunella Amoruso ,&nbsp;Anna Bombelli ,&nbsp;Sara Mariano ,&nbsp;Stefano Stabile ,&nbsp;Camillo Porta ,&nbsp;Salvatore Siena ,&nbsp;Andrea Sartore-Bianchi","doi":"10.1016/j.clcc.2024.02.001","DOIUrl":"10.1016/j.clcc.2024.02.001","url":null,"abstract":"<div><div><span><span>Liquid biopsy<span> using circulating tumor DNA<span> (ctDNA) has emerged as a minimally invasive, timely approach to provide molecular diagnosis and monitor tumor evolution in patients with cancer. Since the molecular landscape of </span></span></span>metastatic colorectal cancer<span><span> (mCRC) is substantially heterogeneous and dynamic over space and time, ctDNA holds significant advantages as a biomarker for this disease. Numerous studies have demonstrated that ctDNA broadly recapitulates the molecular profile of the primary tumor and </span>metastases, and have mainly focused on the genotyping of </span></span><em>RAS</em> and <em>BRAF</em><span>, that is propaedeutic for anti-EGFR treatment selection. However, ctDNA soon broadened its scope towards the assessment of early tumor response, as well as the identification of drug resistance biomarkers to drive potential molecular actionability. In this review article, we provide an overview of the current state-of-the-art of this methodology and its applications, focusing on ongoing clinical trials that employ ctDNA to prospectively guide treatment in patients with mCRC.</span></div></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"23 4","pages":"Pages 295-308"},"PeriodicalIF":3.3,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139926634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survivorship in Early-Stage Rectal Cancer Patients Who Have Received Combined Modality Therapy","authors":"Saboor E. Randhawa ,&nbsp;Laura Tenner","doi":"10.1016/j.clcc.2023.08.002","DOIUrl":"10.1016/j.clcc.2023.08.002","url":null,"abstract":"<div><p><span>Survival rates in early-stage rectal cancer<span><span> patients have increased over the past few decades. Societies such as the National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and European Society of </span>Medical Oncology (ESMO) have proposed guidelines related to cancer </span></span>survivorship<span> care including formal recommendations to address the needs in early-stage rectal cancer survivors. These guidelines, in addition to new clinical research findings in survivorship will be reviewed, specifically looking at physical, psychosocial, and financial concerns in rectal cancer survivorship.</span></p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 4","pages":"Pages 375-382"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10389344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Surgical Management for Relapse After Conversion Hepatectomy for Initially Unresectable Colorectal Liver Metastasis: A Retrospective Cohort Study","authors":"Yijiao Chen ,&nbsp;Dexiang Zhu ,&nbsp;Miao Chen ,&nbsp;Yuqiu Xu ,&nbsp;Qinghai Ye ,&nbsp;Xiaoying Wang ,&nbsp;Pingping Xu ,&nbsp;Qingyang Feng ,&nbsp;Meiling Ji ,&nbsp;Ye Wei ,&nbsp;Jia Fan ,&nbsp;Jianmin Xu","doi":"10.1016/j.clcc.2023.08.007","DOIUrl":"10.1016/j.clcc.2023.08.007","url":null,"abstract":"<div><h3>Background</h3><p>For patients with initially unresectable colorectal liver metastasis<span> (IU-CRLM) receiving conversion therapy, disease relapse after conversion hepatectomy is common. However, few studies have focused on the assessment and management of relapse following conversion hepatectomy for IU-CRLM.</span></p></div><div><h3>Methods</h3><p><span>In the retrospective cohort study<span>, 255 patients with IU-CRLM received conversion therapy and underwent subsequent R0 resection. The treatment effects of repeated liver-directed treatment (RLDT) versus non-RLDT for liver relapse were examined. Survival analysis was evaluated with the use of Cox proportional hazards methods. The importance of RLDT was further confirmed in the </span></span>propensity score matching (PSM) and subgroup analyses.</p></div><div><h3>Results</h3><p>The 5-year overall survival (OS) rate after conversion hepatectomy was 34.9%. Liver relapse was observed in 208 patients. Of these patients, 106 underwent RLDT (65 underwent repeated hepatectomy and the remainder underwent ablation treatment), while 102 received only palliative chemotherapy. The relapse patients who underwent RLDT had a significantly longer OS than those who did not (hazard ratio (HR): 0.382, 95% CI: 0.259-0.563; P&lt;0.001). In a multivariable analysis, RLDT was independently associated to prolonged survival (HR: 0.309, 95%CI: 0.181-0.529; <em>P</em>&lt;0.001). In the PSM and subgroup analyses, RLDT consistently showed evidence of prolonging OS significantly.</p></div><div><h3>Conclusion</h3><p>For IU-CRLM patients with liver relapse following conversion hepatectomy, the RLDT is essential for cure and prolonged survival. To avoid missing the opportunity for RLDT, intensive disease surveillance should be proposed.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 4","pages":"Pages 464-473.e5"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Prescriber Variation in the Duration of Oxaliplatin-Containing Adjuvant Chemotherapy for Stage III Colon Cancer From 2007 to 2019: A Population-Based Retrospective Cohort Study","authors":"Colin Sue-Chue-Lam ,&nbsp;Christine Brezden-Masley ,&nbsp;Rinku Sutradhar ,&nbsp;Amy Y.X. Yu ,&nbsp;Nancy N. Baxter","doi":"10.1016/j.clcc.2023.08.003","DOIUrl":"10.1016/j.clcc.2023.08.003","url":null,"abstract":"<div><h3>Introduction</h3><p>The International Duration Evaluation of Adjuvant Therapy (IDEA) collaboration in 2017 established 3 months of adjuvant therapy as an alternative to 6 months of therapy for stage III colon cancer. We determined the association between the IDEA publication, changes in clinical practice, and prescriber variation.</p></div><div><h3>Patients and Methods</h3><p>Using linked databases, we identified Ontarians aged ≥18 years at diagnosis of stage III colon cancer between 2007 and 2019 who received oxaliplatin-containing adjuvant therapy. The outcome was duration of therapy, categorized as ≤25%, &gt;25% to ≤50%, &gt;50% to ≤75%, and &gt;75% of a 6-month course of therapy to approximate treatment durations in the IDEA collaboration. We examined trends in duration over time using an interrupted time series regression model. We analyzed treatment duration after accounting for patient and prescriber characteristics, using multivariable mixed effects logistic regression models to quantify between-prescriber variation.</p></div><div><h3>Results</h3><p>We included 4695 patients with stage III colon cancer who received oxaliplatin-containing adjuvant chemotherapy, of whom 77.5% initiated treatment pre-IDEA and 22.5% initiated treatment post-IDEA. Post-IDEA, there was a 16.4% (95% CI, 12.5%-20.3%) absolute increase in the proportion of patients treated with ≤50% of a maximal course of therapy. This trend was greatest among patients with low-risk tumors. Prescriber variation increased pre-IDEA to 15.6% post-IDEA (variance partition coefficient 5.4% pre-IDEA and 15.6% post-IDEA).</p></div><div><h3>Conclusion</h3><p>The publication of IDEA was associated with increases in short duration adjuvant therapy and prescriber-level practice variation for stage III colon cancer. Clinicians should be better supported to make consistent recommendations about adjuvant duration under conditions of uncertainty and trade-offs.</p></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"22 4","pages":"Pages 431-441.e9"},"PeriodicalIF":3.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1533002823000762/pdfft?md5=27a640540349ee3fb93c6f858654aafe&pid=1-s2.0-S1533002823000762-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}